NR 511 MIDTERM EXAM QUESTIONS & CORRECT
ANSWERS LATEST 2026
Mr. Johnson, age 69, presents to the clinic for evaluation and treatment of acute
onset vertigo. You diagnose him with benign paroxysmal positional vertigo and
perform Epley's maneuvers, after which you provide him and his wife with
instruction to repeat the maneuvers at home. One week later, he returns for follow-
up and reports that there has been no improvement. What do you recognize that
this implies?
The patient does not have otoliths and the dx must be reconsidered
A patient has been treated for acute otitis media and presents 2 weeks later for
follow-up. Things are much improved, there is no pain, and there is no
lymphadenopathy. Physical examination reveals air-fluid levels, and the patient
does admit to a sense of ear fullness. What is the most appropriate approach to help
this patient?
Reassure that this is a normal finding
A 12-year-old male presents to your pediatric clinic with his mother complaining
of ear pain. He has a membership to a local swim club and spends multiple days
there a week. He has had purulent drainage from his ear for 1 day. The patient had
no constitutional symptoms and normal vital signs. He is painful to palpation of his
tragus, and on exam you cannot see his tympanic membrane. His ear canal is
edematous and erythematous, with purulent discharge present. What is the likely
pathogen causing these symptoms?
Pseudomonas Aeruginosa
Mrs. Milne is a 72-year-old woman who presents for her annual primary care
examination. During the review of systems, she admits to having some "visual
floaters" and infrequent "flashes of light." She denies any pain and says that she
was not concerned because she read somewhere that these were normal and just
happened sometimes. She denies any visual changes or eye pain. The APRN
recognizes that due to her age, Mrs. Milne is at increased risk for which condition
that may cause these symptoms?
,Posterior Vitreous Detachment
Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for
a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis.
What is one distinguishing characteristic between the two?
Conjunctival injection w/o discharge
A 10-year-old male in 5th grade presents to the pediatric office with his mother
complaining of itchy and red eyes for 1 day. The patient complains of watery
drainage in both eyes, associated with repetitive itching. On physical exam, he has
no fever or constitutional symptoms. His vision is normal, with no decrease in
extraocular movements. The patient has a sibling that just started day care recently.
He also has bilateral preauricular lymph nodes that are inflamed. What is the
patient's diagnosis?
Viral Conjunctivitis
Which of the following statements about macular degeneration is NOT true?
Macular degeneration is characterized by gradual loss of peripheral vision
Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red
eye without discharge. What should you suspect?
Iritis
- patients rarely have discharge
Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil
shape, marked photophobia, and redness around the iris. What is your initial
diagnosis?
Iritis
- If a patient has throbbing pain in the eye, an irregular pupil shape, marked
photophobia, and redness (a deep, dull, red halo or ciliary flush) around the iris
and/or cornea, suspect iritis. An immediate referral is warranted. The patient may
also have blurred vision.
Mr. Hook is a 69-year-old male who was seen 2 weeks ago for evaluation of eye
itching and a feeling like "sand in my eye." He was diagnosed with blepharitis and
treated with conservative measures including baby shampoo cleansing. Today, at a
,1-month follow-up, he has no improvement of symptoms. What is the most
appropriate action at this point?
Refer Mr. Hook to an ophthalmologist
Which of the following is NOT a complication of untreated group A streptococcal
pharyngitis?
Hemolytic Anemia
When you are assessing the internal structure of the eye of your 59-year-old
patient, what might the absence of a red reflex indicate?
A cataract or hemorrhage into the vitreous humor
A 65-year-old man presents complaining of a left-sided, deep, throbbing headache
and mild fatigue. On examination, the patient has a tender, tortuous temporal
artery. You suspect giant cell arteritis (GCA), or temporal arteritis. What is the
least invasive procedure to help with diagnosis?
Erythrocyte Sedimentation rate (ESR)
When the Weber test is performed with a tuning fork to assess hearing and there is
no lateralization, how should the nurse practitioner document this finding?
a normal finding
A 25-year-old patient who plays in a band complains that he finds it difficult to
understand his fellow musicians at the end of a night of performing, a problem that
is compounded by the noisy environment of the club. These symptoms are most
characteristic of which of the following?
Sensorineural Loss
- Sensorineural loss comes from exposure to loud noises, inner ear infections,
tumors, congenital and familial disorders, and aging. The results of the Weber and
Rinne tests will assist in the diagnosis.
Ms. Brierly presents complaining of unilateral pulsatile tinnitus in the left ear for
approximately 6 months. She has no significant medical history and has started no
new medications. The nurse practitioner (NP) knows that the next step for this
patient should include which?
, MRI
- r/o vascular causes
All of the following medications may cause alopecia except which?
Minoxidil
A 22-year-old African-American female presents to your family practice office
complaining of progressive skin discoloration. She is adopted and has no known
family history of skin problems. The patient notes nonpalpable patches of pigment
loss and blanching of her forehead and both hands and feet. It has developed over a
period of 6 months and appears to have stopped. It is not pruritic, and there is no
erythema or sign of infectious etiology. What is the most likely diagnosis?
Vitilligo
Linda is the 26-year-old mother of Alysia, a 2-year-old girl of African descent.
Linda is concerned that Alysia has a large area on her sternum that is much paler
that the rest of her skin. What is the appropriate response Linda?
This is a normal finding in up to 70% of black children and may resolve with age.
Which of the following patients would NOT be at risk for Candida infection?
a patient with hx of CAD
Bob, age 59, has a nevus on his shoulder that has recently changed from brown to
bluish black. What do you advise him to do?
have an excisional biopsy
The ABCDEs (asymmetry, border, color, diameter, evolution) of melanomas
should be taught to all patients. A change in color may indicate a melanoma, and
an excisional biopsy should be done.
The nurse practitioner (NP) tells Samantha, age 52, that she has an acrochordon on
her neck. What is the NP referring to?
A skin tag
Skin tags (acrochordons) are benign overgrowths of skin commonly seen after
middle age and usually found on the neck, axillae, groin, upper trunk, and eyelids.
ANSWERS LATEST 2026
Mr. Johnson, age 69, presents to the clinic for evaluation and treatment of acute
onset vertigo. You diagnose him with benign paroxysmal positional vertigo and
perform Epley's maneuvers, after which you provide him and his wife with
instruction to repeat the maneuvers at home. One week later, he returns for follow-
up and reports that there has been no improvement. What do you recognize that
this implies?
The patient does not have otoliths and the dx must be reconsidered
A patient has been treated for acute otitis media and presents 2 weeks later for
follow-up. Things are much improved, there is no pain, and there is no
lymphadenopathy. Physical examination reveals air-fluid levels, and the patient
does admit to a sense of ear fullness. What is the most appropriate approach to help
this patient?
Reassure that this is a normal finding
A 12-year-old male presents to your pediatric clinic with his mother complaining
of ear pain. He has a membership to a local swim club and spends multiple days
there a week. He has had purulent drainage from his ear for 1 day. The patient had
no constitutional symptoms and normal vital signs. He is painful to palpation of his
tragus, and on exam you cannot see his tympanic membrane. His ear canal is
edematous and erythematous, with purulent discharge present. What is the likely
pathogen causing these symptoms?
Pseudomonas Aeruginosa
Mrs. Milne is a 72-year-old woman who presents for her annual primary care
examination. During the review of systems, she admits to having some "visual
floaters" and infrequent "flashes of light." She denies any pain and says that she
was not concerned because she read somewhere that these were normal and just
happened sometimes. She denies any visual changes or eye pain. The APRN
recognizes that due to her age, Mrs. Milne is at increased risk for which condition
that may cause these symptoms?
,Posterior Vitreous Detachment
Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for
a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis.
What is one distinguishing characteristic between the two?
Conjunctival injection w/o discharge
A 10-year-old male in 5th grade presents to the pediatric office with his mother
complaining of itchy and red eyes for 1 day. The patient complains of watery
drainage in both eyes, associated with repetitive itching. On physical exam, he has
no fever or constitutional symptoms. His vision is normal, with no decrease in
extraocular movements. The patient has a sibling that just started day care recently.
He also has bilateral preauricular lymph nodes that are inflamed. What is the
patient's diagnosis?
Viral Conjunctivitis
Which of the following statements about macular degeneration is NOT true?
Macular degeneration is characterized by gradual loss of peripheral vision
Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red
eye without discharge. What should you suspect?
Iritis
- patients rarely have discharge
Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil
shape, marked photophobia, and redness around the iris. What is your initial
diagnosis?
Iritis
- If a patient has throbbing pain in the eye, an irregular pupil shape, marked
photophobia, and redness (a deep, dull, red halo or ciliary flush) around the iris
and/or cornea, suspect iritis. An immediate referral is warranted. The patient may
also have blurred vision.
Mr. Hook is a 69-year-old male who was seen 2 weeks ago for evaluation of eye
itching and a feeling like "sand in my eye." He was diagnosed with blepharitis and
treated with conservative measures including baby shampoo cleansing. Today, at a
,1-month follow-up, he has no improvement of symptoms. What is the most
appropriate action at this point?
Refer Mr. Hook to an ophthalmologist
Which of the following is NOT a complication of untreated group A streptococcal
pharyngitis?
Hemolytic Anemia
When you are assessing the internal structure of the eye of your 59-year-old
patient, what might the absence of a red reflex indicate?
A cataract or hemorrhage into the vitreous humor
A 65-year-old man presents complaining of a left-sided, deep, throbbing headache
and mild fatigue. On examination, the patient has a tender, tortuous temporal
artery. You suspect giant cell arteritis (GCA), or temporal arteritis. What is the
least invasive procedure to help with diagnosis?
Erythrocyte Sedimentation rate (ESR)
When the Weber test is performed with a tuning fork to assess hearing and there is
no lateralization, how should the nurse practitioner document this finding?
a normal finding
A 25-year-old patient who plays in a band complains that he finds it difficult to
understand his fellow musicians at the end of a night of performing, a problem that
is compounded by the noisy environment of the club. These symptoms are most
characteristic of which of the following?
Sensorineural Loss
- Sensorineural loss comes from exposure to loud noises, inner ear infections,
tumors, congenital and familial disorders, and aging. The results of the Weber and
Rinne tests will assist in the diagnosis.
Ms. Brierly presents complaining of unilateral pulsatile tinnitus in the left ear for
approximately 6 months. She has no significant medical history and has started no
new medications. The nurse practitioner (NP) knows that the next step for this
patient should include which?
, MRI
- r/o vascular causes
All of the following medications may cause alopecia except which?
Minoxidil
A 22-year-old African-American female presents to your family practice office
complaining of progressive skin discoloration. She is adopted and has no known
family history of skin problems. The patient notes nonpalpable patches of pigment
loss and blanching of her forehead and both hands and feet. It has developed over a
period of 6 months and appears to have stopped. It is not pruritic, and there is no
erythema or sign of infectious etiology. What is the most likely diagnosis?
Vitilligo
Linda is the 26-year-old mother of Alysia, a 2-year-old girl of African descent.
Linda is concerned that Alysia has a large area on her sternum that is much paler
that the rest of her skin. What is the appropriate response Linda?
This is a normal finding in up to 70% of black children and may resolve with age.
Which of the following patients would NOT be at risk for Candida infection?
a patient with hx of CAD
Bob, age 59, has a nevus on his shoulder that has recently changed from brown to
bluish black. What do you advise him to do?
have an excisional biopsy
The ABCDEs (asymmetry, border, color, diameter, evolution) of melanomas
should be taught to all patients. A change in color may indicate a melanoma, and
an excisional biopsy should be done.
The nurse practitioner (NP) tells Samantha, age 52, that she has an acrochordon on
her neck. What is the NP referring to?
A skin tag
Skin tags (acrochordons) are benign overgrowths of skin commonly seen after
middle age and usually found on the neck, axillae, groin, upper trunk, and eyelids.
